This summary is about cardiopulmonary syndromes in adults and children with cancer. Section titles show when the information is about children.

Dyspnea During Advanced Cancer

Key Points

Many conditions can cause dyspnea.

A diagnosis of the cause of dyspnea helps to plan treatment.

It may be possible to treat the cause of dyspnea.

Treatment of dyspnea depends on the cause of it.

Treatment may be to control the signs and symptoms of dyspnea.

Many conditions can cause dyspnea.

Dyspnea is the feeling of difficult or uncomfortable breathing or of not getting enough air. It also may be called shortness of breath, breathlessness, or air hunger. In cancer patients, causes of dyspnea include the following:

A diagnosis of the cause of dyspnea helps to plan treatment.

Physical exam and history: An exam of the body to check general signs of health, including checking for signs or symptoms of dyspnea, such as breathing fast or using the neck or chest muscles to breathe. A history of your health habits and past illnesses and treatments will also be taken.
Your doctor will also ask about when the dyspnea occurs, what it feels like, other signs or symptoms that happen at the same time as the dyspnea, and anything that makes it better or worse.

Functional assessment: An exam to check for how the dyspnea affects your ability to perform activities of daily living such as eating, bathing, or climbing stairs. This exam may include a 6-minute walk test (6MWT) to measure how far you can walk on a flat, hard surface in 6 minutes.

Chest x-ray:
An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.Enlarge

X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Complete blood count: A procedure in which a sample of blood is taken and checked for the following:

Oxygen saturation test: A procedure to check for the amount of oxygen being carried by the red blood cells. A lower than normal amount of oxygen may be a sign of lung disease or other health problems. One method uses a device clipped to the finger. The device senses the amount of oxygen in the blood flowing through the small blood vessels in the finger. Another method uses a sample of blood taken from an artery, usually in the wrist, that is tested for the amount of oxygen.

Maximum inspiratory pressure (MIP) test: The MIP is the highest pressure that can be reached in the lungs when you take a deep breath. When you breathe through a device called a manometer, the device measures the pressure. The information is sent to a computer. The pressure level shows how strong the breathing muscles are.

It may be possible to treat the cause of dyspnea.

Treatment may include the following:

Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the cancer.

Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Laser therapy for tumors inside large airways: Use of a laser beam (a narrow beam of intense light) as a knife to remove the tumor.

Cauterization of tumors inside large airways: Use of a hot instrument, an electric current, or a caustic substance to destroy the tumor.

Treatment may be to control the signs and symptoms of dyspnea.

Treatment to control the signs and symptoms of dyspnea may include the following:

Oxygen therapy: Patients who cannot get enough oxygen from the air may be given extra oxygen to inhale from a tank. Devices that increase the amount of oxygen already in the air may also be prescribed.

Medicines: Opioids, such as morphine, may lessen physical and mental distress and exhaustion and the feeling that the patient cannot take in enough air. Other drugs may be used to treat dyspnea that is related to panicdisorder or severe anxiety.

Malignant Pleural Effusion

Key Points

Pleural effusion may be caused by cancer, cancer treatment, or other conditions.

A diagnosis of the cause of pleural effusion is important in planning treatment.

Treatment may be to control signs and symptoms of pleural effusion and improve quality of life.

Pleural effusion is extra fluid around the lungs.

The pleural cavity is the space between the pleura (thin layer of tissue) that covers the outer surface of each lung and lines the inner wall of the chest cavity.
Pleural tissue usually makes a small amount of fluid that helps the lungs move smoothly in the chest while a person is breathing. A pleural effusion is extra fluid in the pleural cavity. The fluid presses on the lungs and makes it hard to breathe.

Pleural effusion may be caused by cancer, cancer treatment, or other conditions.

Treatment for a malignant pleural effusion is different from treatment for a nonmalignant effusion, so the right diagnosis is important. Diagnostic tests include the following:

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.Enlarge

X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.

CT scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells. This procedure may be used to reduce pressure on the lungs.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If thoracentesis is not possible, a biopsy may be done during a thoracoscopy. A thoracoscopy is a procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube with a lens for viewing) is inserted into the chest. A cutting tool at the end of the thoracoscope is used to remove a sample of tissue.

The type of cancer, previous treatment for cancer, and the patient's wishes also are important in planning treatment.

Treatment may be to control signs and symptoms of pleural effusion and improve quality of life.

A malignant pleural effusion often occurs in cancer that is advanced , cannot be removed by surgery, or continues to grow or spread during treatment. It is also common during the last few weeks of life. The goal of treatment is usually palliative, to relieve signs and symptoms and improve quality of life.

Treatment of the signs and symptoms of malignant pleural effusion includes the following:

Thoracentesis

Thoracentesis is a procedure to remove extra fluid from the pleural cavity using a needle and/or a thin, plastic tube. Removal of the fluid may help to relieve severe symptoms for a short time. A few days after the extra fluid is removed, it is likely it will begin to come back. The risk of a thoracentesis includes bleeding, infection, collapsed lung, fluid in the lungs, and low blood pressure.

Indwelling pleural catheter (IPC)

An indwelling pleural catheter (IPC) is a small tube that is inserted and left in place to keep fluid from building up around the lungs. One end of the tube stays inside the chest and the other passes outside the body to allow fluid to drain. This type of catheter may be used for long-term care so that a separate procedure won't need to be done each time draining is needed. Risks of IPCs include infection and blockage of the catheter.

Pleurodesis

This is a procedure to close the pleural space so that fluid
cannot collect there. Fluid is first removed by thoracentesis, using a chest tube. A drug that causes the pleural space to close is then inserted into the space through a chest tube. Drugs such as bleomycin or talc may be used.

Surgery

Surgery may be done to put in a shunt (tube) to carry the fluid from the pleural cavity to the abdominal cavity, where the
fluid is easier to remove. Pleurectomy is another type of surgery that may be used. In this procedure, the part of the pleura that lines the chest cavity is removed.

Malignant Pericardial Effusion

Key Points

Pericardial effusion is extra fluid around the heart.

Pericardial effusion may be caused by cancer or other conditions.

Signs and symptoms of pericardial effusion include dyspnea (shortness of breath) and anxiety.

Treatment may be to control the symptoms of pericardial effusion and improve quality of life.

Pericardial effusion is extra fluid around the heart.

Pericardial effusion is extra fluid inside the sac that surrounds the heart. The extra fluid causes pressure on the heart, which stops it from pumping blood normally. Lymph vessels may also be blocked, which often causes bacterial or viralinfections.
If fluid builds up quickly, a condition called cardiac tamponade may occur. In cardiac tamponade, the heart cannot pump enough blood to the rest of the body. This is life-threatening and must be treated right away.

Signs and symptoms of pericardial effusion include dyspnea (shortness of breath) and anxiety.

At first, a pericardial effusion may not cause any signs or symptoms. These and other signs and symptoms may be caused by a pericardial effusion or by other conditions. Check with your doctor if you have any of the following:

Pericardial effusion usually occurs in advanced cancer or in the last few weeks of life. During these times, it may be more important to relieve the symptoms than to diagnose the condition. However, in some cases, the following tests and procedures may be used to diagnose pericardial effusion:

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.Enlarge

X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.

Echocardiography:
A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs of the chest. The echoes form a picture of the heart's position, motion of the walls, and internal parts such as the valves.

Electrocardiogram (EKG or ECG): A line graph recording of the heart's electrical activity to check its rate and rhythm. A number of electrodes (small pads) are placed on the patient’s chest, arms, and legs. The electrodes are connected by wires to the EKG machine. Heart activity is then recorded on paper. Electrical activity that is faster or slower than normal may be a sign of heart problems.

Pericardiocentesis: A procedure to remove fluid from the pericardium using a needle inserted through the chest wall. The doctor may use echocardiography to watch the movement of the heart and needle inside the chest. The fluid is viewed under a microscope by a pathologist to check for cancer cells or signs of infection. This procedure can also be used to treat pericardial effusion. Removing the fluid lessens the pressure on the heart.

Treatment may be to control the symptoms of pericardial effusion and improve quality of life.

A procedure to remove the extra fluid from the sac around the heart using a needle inserted through the chest wall. The doctor may use echocardiography to watch the movement of the heart and needle inside the chest. Removing the fluid can reduce pressure on the heart. In some patients, fluid may again collect in the sac around the heart after pericardiocentesis. A catheter (flexible tube used to put fluids into or take blood out of a vein) may be inserted and left in place so the fluid will keep draining. For patients with advanced cancer, this procedure may be used instead of more serious surgery.

Pericardial sclerosis

A procedure to close the pericardial space so fluid cannot collect in the sac around the heart. Fluid is first removed by pericardiocentesis. A drug or chemical is then injected through a catheter (flexible tube used to put fluids into or take blood out of a vein) into the pericardial space to cause it to close. Three or more treatments may be needed to completely close the pericardial space.

Pericardiotomy

A procedure to insert a drainage tube. An incision (cut) is made in the chest and then in the pericardium and a drainage tube is put in place. This increases the amount of fluid that can be drained from the pericardium.

Pericardiectomy

Surgery to remove part of the pericardium. This may be done to drain fluid quickly when cardiac tamponade occurs. This surgery is also called pericardial window.

Balloon pericardiostomy

A catheter (flexible tube used to put fluids into or take blood out of a vein) with a balloon tip is inserted through the chest and into the pericardium. The balloon is then inflated to make the pericardial opening bigger. The balloon is then deflated and removed. The bigger opening allows the fluid to drain into the pleural cavity. This may be used when an effusion has recurred (come back) after pericardiocentesis or instead of more serious surgery.

Superior Vena Cava Syndrome

Key Points

Superior vena cava syndrome (SVCS) is a group of signs and symptoms that occur when the superior vena cava is partly blocked.

SVCS is usually caused by cancer.

Common signs and symptoms of SVCS include breathing problems and coughing.

Tests are done to find and diagnose the blockage.

Treatment for SVCS caused by cancer depends on the cause, signs and symptoms, and prognosis.

Palliative care may be given to relieve signs and symptoms in patients with SVCS.

Superior vena cava syndrome (SVCS) is a group of signs and symptoms that occur when the superior vena cava is partly blocked.

The superior vena cava is a major vein that leads to the heart. The heart is divided into four parts. The right and left atrium make up the top parts of the heart and the right and left ventricle make up the bottom parts of the heart. The right atrium of the heart receives blood from two major veins:

The superior vena cava returns blood from the upper body to the heart.

Different conditions can slow the flow of blood through the superior vena cava. These include a tumor in the chest, nearby lymph nodes that are swollen (from cancer), or a blood clot in the superior vena cava. The vein may become completely blocked. Sometimes, smaller veins in the area become larger and take over for the superior vena cava if it is blocked, but this takes time. Superior vena cava syndrome (SVCS) is the group of signs and symptoms that occur when this vein is partly blocked.

SVCS is usually caused by cancer.

Superior vena cava syndrome (SVCS) is usually caused by cancer. In adults, SVCS is most common in the following types of cancer:

A blood clot that forms during the use of an intravenouscatheter (flexible tube used to put fluids into or take blood out of a vein) in the superior vena cava. A clot may also be caused by pacemaker wires.

Infection or cancer in the chest that causes affected tissues to become thick and hard.

Common signs and symptoms of SVCS include breathing problems and coughing.

The signs and symptoms of SVCS are more severe if the vein becomes blocked quickly. This is because the other veins in the area do not have time to widen and take over the blood flow that cannot pass through the superior vena cava.

The most common signs are:

Trouble breathing.

Coughing.

Swelling in the face, neck, upper body, or arms.

Less common signs and symptoms include the following:

Hoarse voice.

Trouble swallowing or talking.

Coughing up blood.

Swollen veins in the chest or neck.

Chest pain.

Reddish skin color.

Tests are done to find and diagnose the blockage.

The following tests may be done to diagnose SVCS and find the blockage:

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.Enlarge

X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Venography: A procedure to x-ray veins. A contrast dye is injected into the veins to outline them on the x-rays.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

It is important to find out the cause of SVCS before starting treatment. The type of cancer can affect the type of treatment needed. Unless the airway is blocked or the brain is swelling, waiting to start treatment while a diagnosis is made usually causes no problem in adults. If doctors think lung cancer is causing the problem, a sputum sample may be taken and a biopsy may be done.

Treatment for SVCS caused by cancer depends on the cause, signs and symptoms, and prognosis.

Watchful waiting is closely monitoring a patient’s condition without giving any treatment unless signs or symptoms appear or change. A patient who has good blood flow through smaller veins in the area and mild symptoms may not need treatment.

The following may be used to relieve signs or symptoms and keep the patient comfortable:

Diuretics (drugs that make excess fluid pass from the body in urine). Patients taking diuretics are closely watched because these drugs can cause dehydration (loss of too much fluid from the body).

Chemotherapy

Chemotherapy is the usual treatment for tumors that respond to anticancer drugs, including small cell lung cancer and lymphoma. Chemotherapy stops the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

If the blockage of the superior vena cava is caused by a tumor that does not usually respond to chemotherapy, radiation therapy may be given. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. External radiation therapy uses a machine outside the body to send radiation toward the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Thrombolysis

SVCS may occur when a thrombus (blood clot) forms in a partly blocked vein. Thrombolysis is a way to break up and remove blood clots. This may done by a thrombectomy. Thrombectomy is surgery to remove the blood clot or the use of a device inserted into the vein to remove the blood clot. This may be done with or without the use of drugs to break up the clot.

Stent placement

If the superior vena cava is partly blocked by the tumor, an expandable stent (tube) may be placed inside the superior vena cava to help keep it open and allow blood to pass through. This helps most patients.
Drugs to keep more blood clots from forming may also be used.

Surgery

Surgery to bypass (go around) the blocked part of the vein is sometimes used for cancer patients, but is used more often for patients who do not have cancer.

Palliative care may be given to relieve signs and symptoms in patients with SVCS.

Superior vena cava syndrome is serious and the signs and symptoms can be upsetting for the patient and family.
It is important that patients and family members ask questions about superior vena cava syndrome and how to treat it. This can help relieve anxiety about signs and symptoms such as swelling, trouble swallowing, coughing, and hoarseness.

Superior Vena Cava Syndrome in Children

Key Points

Superior vena cava syndrome in a child is a serious medical emergency because the child's windpipe can become blocked.

The most common symptoms of SVCS in children are a lot like those in adults.

The most common cause of SVCS in children is non-Hodgkin lymphoma.

SVCS in children may be diagnosed and treated before a diagnosis of cancer is made.

Superior vena cava syndrome in a child is a serious medical emergency because the child's windpipe can become blocked.

Superior vena cava syndrome (SVCS) in children can be life-threatening. This is because the trachea (windpipe) can quickly become blocked. In adults, the windpipe is fairly stiff, but in children, it is softer and can more easily be squeezed shut. Also, a child's windpipe is narrower, so any amount of swelling can cause breathing problems. Squeezing of the trachea is called superior mediastinalsyndrome (SMS). Because SVCS and SMS usually happen together in children, the two syndromes are considered to be the same.

The most common symptoms of SVCS in children are a lot like those in adults.

SVCS in children may be diagnosed and treated before a diagnosis of cancer is made.

A physical exam, chest x-ray, and medical history are usually all that are needed to diagnose superior vena cava syndrome in children. Even if doctors think cancer is causing SVCS, a biopsy may not be done. This is because the lungs and heart of a child with SVCS may not be able to handle the anesthesia needed. Other imaging tests may be done to help find out if anesthesia can be safely used. In most cases, treatment will begin before a diagnosis of cancer is made.

The following treatments may be used for SVCS in children:

Radiation therapy

Radiation therapy is usually used to treat a tumor that is blocking the vein. After radiation therapy, there may be more trouble breathing because swelling narrows the windpipe. A drug to reduce swelling may be given.

General information about clinical trials is also available from the NCI Web site.

Changes to This Summary (02/13/2015)

The PDQcancer information summaries are reviewed regularly
and updated as new information becomes available. This section
describes the latest changes made to this summary as of the
date above.

Editorial changes were made to this summary.

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This PDQ cancer information summary has current information about the pathophysiology and treatment of cardiopulmonary syndromes, including dyspnea, malignant pleural effusion, malignant pericardial effusion, and superior vena cava syndrome. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

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